Evaluation of the High-Frequency Monopolar Stimulation Technique for Mapping and Monitoring the Corticospinal Tract in Patients With Supratentorial Gliomas. A Proposal for Intraoperative Management Based on Neurophysiological Data Analysis in a Series of 92 Patients
| Autor: | Andreu Gabarrós, Gerard Plans, Isabel Fernández-Conejero, Alejandro Fernández-Coello, Xavier Rifà-Ros, Aleix Rosselló |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Male medicine.medical_specialty Intraoperative Neurophysiological Monitoring Deep Brain Stimulation Pyramidal Tracts Monopolar stimulation Preoperative care 03 medical and health sciences 0302 clinical medicine Glioma medicine Humans In patient Aged Brain Mapping business.industry Brain Neoplasms Neurophysiology Middle Aged medicine.disease Evoked Potentials Motor Surgery 030220 oncology & carcinogenesis Intraoperative management Anesthesia Corticospinal tract Female Neurology (clinical) business Motor deterioration 030217 neurology & neurosurgery |
| Zdroj: | Neurosurgery. 81(4) |
| ISSN: | 1524-4040 |
| Popis: | BACKGROUND Intraoperative identification and preservation of the corticospinal tract is often necessary for glioma resection. OBJECTIVE To make a proposal for intraoperative management with the high-frequency monopolar stimulation technique for monitoring the corticospinal tract. METHODS Ninety-two patients operated on with the assistance of the high-frequency monopolar stimulation. Clinical and neurophysiological data have been related with the motor status at 3 months to establish prognostic factors of motor deterioration. RESULTS Twenty-one patients (22.8%) presented intraoperative alterations in motor-evoked potentials (MEPs). Twelve (13%) presented an increment in the MEP threshold ≥5 mA (no deficit at 3 months). Two (2.2%) presented an MEP amplitude reduction >50% (100% deficit at 3 months). Seven (7.6%) had an intraoperative MEP loss (80% deficit at 3 months). Subcortical stimulation was positive in 75 patients (81.5%). Eighty-five patients were available for the analysis at 3 months. Fourteen presented new deficits (16.5%). Among them, 5 presented a deficit in nonmonitored muscles (5.9%) and 1 presented a new deficit not detected intraoperatively. The combination of patients with preoperative motor deficits, MEP deterioration, or loss and intensity of subcortical stimulation ≤3 mA showed the highest sensitivity and specificity in the prediction of new deficits. CONCLUSIONS Persistent MEP loss or deterioration is associated with a high probability of new deficits. It seems recommendable to stop the subcortical resection before obtaining a subcortical MEP threshold at 3 mA especially in patients with preoperative motor deficits. A careful selection of muscles for the registration of MEPs is mandatory to avoid deficits in nonmonitored muscles. |
| Databáze: | OpenAIRE |
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